SORE NIPPLES

Sore nipples are probably the most common difficulty mothers have when breastfeeding. It is also known as cracked nipples. It is characterized by tenderness and pain. It's normal to feel some tenderness at the beginning of a feed during the first few days of breastfeeding. But severe or lasting pain is not normal. Nipple soreness is almost always a short-term problem, and can usually be corrected in a matter of days.

Cause-
A very high risk period for having sore and cracked nipples is post natal period. There could be many reasons like an improperly positioned newborn or a baby with a very strong suck can result into sore nipples. Sore nipples, over the times, can turn into cracked nipples.

If nipples feel painfully sore or the nipples or areola feel bruised, it is more likely that it is related to an improper latch-on process or ineffective sucking. Suspect a difficulty with baby's latch or sucking if nipples become very red, raw, blistered, or cracked. A latch or sucking difficulty or a structural variation in the baby's mouth might result in nipples that look creased or blanched (turn white) at the end of feedings.

Improper care or hygienic condition can also result in this troublesome situation. Nipples, if remain dry is prime factor that contribute in soreness and cracking. Any wound's ignorance can lead to such condition that again requires major attention before it turns big.

Treatment-
The best treatment of sore nipples is prevention. The best prevention is getting the baby to latch on properly from the first day. This can be done by
A. Proper positioning and latching.

• 1.Positioning-
   At first, it may be easiest for many mothers to use the cross cradle hold to position the baby for latching on. Hold the baby in right arm, pushing in the baby's bottom with the side of the forearm so that hand turns palm upwards (towards the ceiling). This will help in supporting his body more easily as the baby's weight is on your forearm rather than wrist or hand. Holding the baby like this also will bring the baby in from the correct direction so that he gets a good latch. The hand will be palm up under the baby's face (not shoulder or under his neck). The web between thumb and index finger should be behind the nape of his neck (not behind his head). The baby will be almost horizontal across the body, with his head slight tilted backward, and should be turned so that his chest, belly and thighs are against mother with a slight tilt upwards so the baby can look at her mother. Hold the breast with left hand, with the thumb on top and the other fingers underneath, fairly far back from the nipple and areola.
•  The baby should be approaching the breast with the head just slightly tilted backwards. The nipple then automatically points to the roof of the baby's mouth.

• 2. Latching-

• 1.Now, get the baby to open up his mouth wide. The way to do this is to run your nipple, still pointing to the roof of the baby's mouth, along the baby's upper lip (not lower), lightly, just a tickle, from one corner of the mouth to the other. Or you can run the baby along your nipple, something some mothers find easier. Wait for the baby to open up as if yawning. As you bring the baby toward the breast, only his chin should touch your breast. Do not scoop him around so that the nipple points to the middle of his mouth. Instead the nipple should still be pointing to the roof of the baby's mouth.
• 2.When the baby opens up his mouth, use the arm that is holding him to bring him straight (not scooped around) onto the breast. Don't worry about the baby's breathing. If he is properly positioned and latched on, he will breathe without any problem since his nose will be far away from the breast. If he cannot breathe, he will pull away from the breast. If he cannot breathe, he is not latched properly. Don't be afraid to be quick.
• 3.If the nipple still hurts, use your index finger to pull down on the baby's chin; this will bring more of your breast into the baby's mouth. You may have to do this for the duration of the feed, but not usually. The pain should usually subside. Do not take the baby on and off the breast several times to get the perfect latch. If the baby goes on and off the breast 5 times and it hurts, you will have 5 times more pain, and worse, 5 times more damage, and the baby and you will both be frustrated. Adjust the latch when putting him to the other breast, or at the next feeding.
• 4.The same principles apply whether you are sitting or lying down with the baby or using the football or cradle hold. Get the baby to open wide; don't let the baby latch onto the nipple, but get as much of the areola (brown part of breast) into the mouth as possible (not necessarily the whole areola).
• 5.There is no "normal" length of feeding time. If you have questions, call the clinic.
• 6.A baby properly latched on will be covering more of the areola with his lower lip than with the upper lip.

B. Limiting the amount of time of nursing on the sore nipple, always starting with the side that is not sore.
C. Use of bra pads, and changing them frequently to keep nipples dry.
D. Breastfeeding frequently and regularly to avoid nipple confusion and sore nipple.
E. Massage a little hand expressed milk into the nipples after finishing the nursing, and letting them air dry.
F. One can also express a little milk before breastfeeding to regularize the flow of milk.
G. Use of nipple protectors as long as nipples don't heal.

Role of homoeopathy-
Homeopathy can successfully cure sore nipples. Treatment is given to the patient depending on the cause. The medicines act safely without producing side-effects on either the mother or the baby.

Please E-mail dr_ramanand@rediffmail.com for any questions/treatment